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Image Documentation and Textual Operative Description of the Technique and the Findings of Laparoscopic Intraoperative Cholangiography Are Sub-Optimal
Alex Karran*, Ashleigh Majoe, Ashraf M. Rasheed
Gwent Institute of Minimal Access surgery, Newport, United Kingdom
Background
There is a wealth of data to dispute the role of laparoscopic intra-operative cholangiography (IOC) but there little published literature to describe the optimal technique or to recommend a standardised reporting system. The operative report is a legal document that must contain details of all interventions.
Aims
This study aims to examine the details of the technique of IOC and to audit the quality of the captured images and the content of operative notes in relation to documentation of essential IOC anatomical landmarks
Method
A retrospective analysis of 100 consecutive laparoscopic intra-operative cholangiograms that were attempted at the Aneurin Bevan Health Board (ABHB) between February 2009 and March 2010 was undertaken. The visualisation of 7 essential anatomical landmarks on captured IOC images and specific reference made to each in the operation notes were assessed.
Results
A significant inter-operator variability was noted in the performance and the interpretation of IOC. Only 34% of captured images identified all 7 recognised essential IOC landmarks. The majority (63.8%) of operation notes failed to make reference to all 7 landmarks, with a mean number of landmarks referred to as 1. There was a significant difference (p<0.001) between landmarks identified on the captured images and their documentation within the operation notes.
Conclusions
This study confirms that laparoscopic IOC is sub-optimally performed and poorly reported. It highlights the need for standardisation of the IOC technique and systematisation of its reporting.
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